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More than a third of dying elderly patients receive "invasive and potentially harmful" treatments in their last weeks of life, the biggest review of its kind has found.

Analysis of data from 1.2 million patients worldwide found patients being subjected to "excessive" and unnecessary treatments that make no difference to the course of their illness.

Researchers said some of the pressure stemmed from families who struggled to accept that nothing more could be done for their loved ones, and expected "heroic" interventions from doctors.

The review, led by experts at the University of New South Wales in Australia, involved 10 countries, including England, examining the experiences of bereaved families and doctors.

'It is not unusual for family members to refuse to accept the fact that their loved one is naturally dying of old age ... and so they pressure doctors to attempt heroic interventions'Dr Magnolia Cardona-Morrell, University of New South Wales

Published in the International Journal for Quality in Health Care, it found around a third of elderly patients with advanced, irreversible conditions - such as cancer - were given treatments that were of no benefit to them.

One third of terminally-ill cancer patients were given chemotherapy in the last six weeks of life, while 10 per cent of all patients in irreversible decline were admitted to intensive care units.

A third such patients were given antibiotics and heart medicines, while almost as many were put through dialysis, blood transfusions or other life support.

A quarter of patients who had Do Not Resuscitate (DNR) orders in their notes were resuscitated, while up to half of such patients underwent invasive blood tests and scans, the study found.

Researchers a number of patients also underwent intensive monitoring, despite the fact that such steps made "little or no" difference to the outcome and might have prevented a comfortable death, researchers said.

'Television and film is often guilty of depicting medicine as a heroic battle rather than something that’s facilitating a natural lifespan'Professor Bill Noble, Marie Curie

Dr Magnolia Cardona-Morrell, who led the research at the university's Simpson Centre for Health Services Research, said big advances in medical technology have led to "unrealistic" expectations about what doctors can achieve.

She said: "It is not unusual for family members to refuse to accept the fact that their loved one is naturally dying of old age and its associated complications and so they pressure doctors to attempt heroic interventions."

Doctors struggled with the uncertain trajectory of death, and were "torn by the ethical dilemna" that they were trained to save lives, instead of focussing on the patient's right to die with dignity, she said.

Many medics worked in a culture which promoted "doing everything possible" researchers said, while there was a lack of agreement about when treatment was futile.

Dr Cardona-Morrell said non-beneficial treatments should be regarded as those which "prolong suffering rather than survival, that can potentially cause harm, and are sometimes given against patients' wishes".

She called for "honest and open" discussions with patients or their families as a way of avoiding treatments that would not help prolong life.

She added: "More training for doctors will help them let go of the fear of a wrong prognosis, because they will be better able to identify patients near the end of life.

England was one of 10 countries which took part in the major international study Credit:
Dominic Lipinksi/PA

"As a community we must also stop shying away from the topic of death. Start a discussion now with your elderly loves ones about their end of life care preferences before they become too ill to have that conversation."

Professor Bill Noble, Medical Director at the terminal illness charity, Marie Curie, said early access to palliative care helped patients and families to have “honest conversations” about treatment options, and what to expect as a condition progressed.

“This makes harmful interventions at the end of someone’s life less likely and helps families deal with their impending bereavement,” he said.

Prof Noble said families often had unrealistic expectations about what medics could do.

“Television and film is often guilty of depicting medicine as a heroic battle rather than something that’s facilitating a natural lifespan. This damaging portrayal perpetuates the unrealistic expectations about what doctors can do for patients, especially those with terminal illnesses who might be approaching the end of their lives,” he said.